Oxford Gym Reimbursement printable pdf download

Gym Reimbursement

Receive reimbursement for visiting the gym.

Stay in shape with Oxford

How much can I get reimbursed?

Starting or staying with an exercise routine isn’t always

For Oxford to reimburse you in accordance with this

easy. To help you stay motivated and achieve your fitness

benefit, the following steps must be taken:

goals, Oxford provides limited reimbursement toward

1. Gym visits

fitness center membership fees.

The reimbursement

benefit is limited to you and your spouse/domestic

You must complete a minimum of 50 visits per six-month

period (you must wait until six months has passed even

partner

; no other dependents are eligible. In order for your

spouse/domestic partner

to be eligible for this benefit, he

if you complete 50 visits sooner than six months).

or she must also be enrolled as an Oxford Member.

2. Reimbursement value

Selecting a gym

Oxford offers employer groups two reimbursement

options, depending on where your company is located:

To receive reimbursement, you must participate in a gym

and/or program that promotes cardiovascular wellness.

•

Oxford subscribers receive up to a $200

Memberships in sports clubs, country clubs, weight loss

reimbursement per six-month period; covered

clinics, spas, or other similar facilities will not be reimbursed.

spouses/domestic partners

receive up to a

$100 reimbursement per six-month period.

For a gym to be considered eligible, it must provide at

least two pieces of equipment or activities that promote

•

Oxford subscribers receive up to a $100

cardiovascular wellness from the following list:

reimbursement per six-month period; covered

spouses/domestic partners

receive up to a

stationary bicycle

$50 reimbursement per six-month period.

treadmill

3. Send paperwork

elliptical crosstrainer

Provide a copy of your gym’s current bill, showing the

monthly cost of your membership, along with a brochure

group exercise

that outlines the services the facility offers.

squash/tennis/racquetball courts

4. Fill out form

stepper

Fill out the Gym Reimbursement Form on the reverse

side. (You may obtain additional forms from your benefits

rowing machine

administrator, our web site at , or

by calling Oxford Customer Service.) Have a facility

walking/running group

representative sign the form.

pool

5. Mail form

Submit the Gym Reimbursement Form to the address

on the form.

If you have any questions regarding

gym reimbursement, please call

Customer Service at 1-800-444-6222.

1 This level of reimbursement is not available to Members of all groups and is not available to Connecticut groups. Check your Certificate of Coverage to determine

eligibility for this reimbursement. Oxford subscribers and covered spouses/domestic partners will receive the lesser of their corresponding reimbursement amount

or the facility membership fee per six-month period.

2 Reimbursement for domestic partners is limited to Members of groups that have purchased domestic partners coverage. Oxford Members and their

spouses/domestic partners must be covered Oxford Members for the entire six-month period to receive reimbursement.

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